title: Adipocytokines and risk of stroke in older people: a nested case-control study.
abstract: BACKGROUND
  Inflammation may play an important role in atherothrombosis and in promoting cerebral damage after stroke. We hypothesized that plasma adipocytokine concentrations would be associated with risk of stroke in older people.
  
  
  METHODS
  Nested case-control study from the Prospective Study of Pravastatin in the Elderly (PROSPER). Subjects were aged 70-82 years and followed up for a mean of 3.2 years: 266 incident stroke cases (179 confirmed as ischaemic) were compared with 532 controls matched for age, gender and treatment allocation (pravastatin or placebo). Adipocytokines [adiponectin, interleukin- (IL-)18 and tumour necrosis factor (TNF)alpha] were measured on stored baseline plasma samples.
  
  
  RESULTS
  Elevated plasma adiponectin was associated with lower risk of ischaemic stroke on univariate analysis: odds ratio (OR) 0.78 per 1 SD increase (95% CI 0.62-0.97). There were no associations of IL-18 or TNFalpha with risk for ischaemic or total strokes. In multivariate models the independent predictors of ischaemic stroke were prior cerebrovascular accident (OR 2.68, 95% CI 1.60-4.50), any alcohol use (1.98, 1.33-2.94), triglycerides (1.40, 1.11-1.77), Barthel score (0.75, 0.58-0.96) and known diabetes (1.72, 1.04-2.83); adiponectin, IL-18 and TNFalpha did not contribute. A similar pattern of risk was seen for total stroke.
  
  
  CONCLUSIONS
  Reduced adiponectin may have a modest role in the aetiology of ischaemic stroke in older people, however IL-18 and TNFalpha are unlikely to play any important part. These adipocytokines do not have clinical predictive utility; history of prior cerebrovascular accident, known diabetes mellitus, prior disability and higher alcohol intake explain much of the stroke risk.
authors.affiliation: Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Scotland, UK. d.j.stott@clinmed.gla.ac.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.forename: Paul
authors.initials: P
authors.lastname: Welsh
authors.forename: Ann
authors.initials: A
authors.lastname: Rumley
authors.forename: Michele
authors.initials: M
authors.lastname: Robertson
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Rudi G J
authors.initials: RG
authors.lastname: Westendorp
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Stuart M
authors.initials: SM
authors.lastname: Cobbe
authors.forename: Gordon D O
authors.initials: GD
authors.lastname: Lowe
mesh_terms: D054392:Adipokines / Q000097:blood*; D052242:Adiponectin / Q000097:blood; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000097:blood / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications; D020382:Interleukin-18 / Q000097:blood; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D012008:Recurrence; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000453:epidemiology / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
chemical_list: C499918:ADIPOQ protein, human; D054392:Adipokines; D052242:Adiponectin; D015415:Biomarkers; D020382:Interleukin-18; D014409:Tumor Necrosis Factor-alpha